Psychosocial interventions, particularly
motivational interviewing (MI) and motivational
enhancement therapy (MET), are regarded as
effective approaches for older adults, especially
those who may resist changing their substance
use behavior.^96
Before prescribing a potentially addictive
medication to an adult patient, a full assessment
of the patient’s use of other addictive substances
and deliberate counseling with regard to the
risks of physical dependence and the dangers of
combining addictive substances is necessary.
When treating older patients with
pharmaceutical therapy, long-acting
benzodiazepines and disulfiram should be
avoided because of their toxicity. Naltrexone
has been tolerated well by older adults and there
is some evidence of its effectiveness in this
population.^97
To improve treatment compliance, older patients
also may require specialized services to assure
appropriate interventions for dietary deficiencies
or auditory or visual impairments; to provide
psychosocial interventions that help patients
cope with loneliness, loss or depression which
are more common in this age group; and to help
bolster supportive social networks.^98
Racial and Ethnic Minorities ...........................................................................................
Treatment providers should take into
consideration the substance-related health
disparities--including the likelihood of co-
occurring disorders--that exist among
racial/ethnic groups.* 99 Different racial/ethnic
groups also may vary in their metabolism,
response to dosages and side effects of
pharmaceutical interventions for addiction.^100
While data are not available on specific
psychosocial therapies that work best for
- e.g., Whites and Hispanics have a higher severity of
alcohol problems than other racial/ethnic groups (see
Chapter III); Hispanic and black men have higher
rates of cirrhosis mortality than white men; and
Alaska Native and white men report higher rates of
alcohol-related and non–alcohol-related major
depressive disorder than Hispanic and black men.
particular racial/ethnic groups, treatment
providers should ensure that programs are
effective for individuals of every racial and
ethnic background by making them sensitive to
racial, ethnic and cultural conditions that may
affect the treatment process.^101 For example,
providers should make sure that language
barriers are addressed and require cultural
competency training for staff.^102 These
measures improve communication and increase
trust and understanding, which in turn result in
greater recognition of patients’ needs, increased
patient engagement in treatment and better
treatment compliance.^103Individuals of Minority Sexual Orientation .....................................................................
Treatment goals for lesbian, gay, bisexual and
transgender (LGBT) individuals are the same as
treatment goals for other individuals in terms of
reducing use or achieving abstinence, but
treatment should also focus on the unique
characteristics of LGBT patients. For example,
higher rates of discrimination against lesbian,
gay and bisexual adults may be associated with
higher rates of risky use and addiction in this
population, compared with heterosexuals.^104Treatment providers should screen for other
health problems and adverse experiences that
may be more common in the LGBT population
including co-occurring mental health disorders,
suicidal thoughts or behaviors, sexually-
transmitted infections (in particular HIV/AIDS
and hepatitis A and B) and sexual abuse.^105 Gay
and bisexual men make up nearly half of those
living with HIV in the United States;^106 the
prevalence of mental health disorders is higher
among lesbian, gay and bisexual adults† than
among heterosexual adults;‡ 107 and a review
study found that lifetime prevalence estimates of
sexual abuse range from 15.6 percent to 85.0
percent for lesbian or bisexual women and from
11.8 percent to 54.0 percent for gay or bisexual
men.^108† Or those who report same-sex sexual partners.
‡ Or those who report opposite-sex sexual partners.